title: Effect of vacuum spine board immobilization on incidence of pressure ulcers during evacuation of military casualties from theater.
abstract: BACKGROUND
  In the summer of 2009, the vacuum spine board (VSB) was designated by the US Air Force as the preferred method of external spinal immobilization during aeromedical transport of patients with suspected unstable thoracolumbar spine fractures. One purported advantage of the VSB is that, by distributing weight over a larger surface area, it decreases the risk of skin pressure ulceration.
  
  
  OBJECTIVE
  To examine whether the rate of pressure ulcers has changed since the introduction of the VSB.
  
  
  METHODS
  Retrospective cohorts.
  
  
  METHODS
  Injured US service members undergoing spinal immobilization during evacuation from the Iraq and Afghanistan theaters to Landstuhl, Germany.
  
  
  METHODS
  Presence and stage of pressure ulceration, and deterioration in neurologic status.
  
  
  METHODS
  Records of the initial 60 patients medically evacuated on the VSB to Landstuhl Regional Medical Center were retrospectively analyzed for patient demographics, injury characteristics, and incidence of pressure injury. The incidence of pressure ulcers after the use of VSB was compared with that in a historical control consisting of 30 patients with unstable spinal injuries evacuated before the introduction of the VSB. No sources of external funding were used for this investigation.
  
  
  RESULTS
  The combined cohort had a mean age of 28.8 years and mean Injury Severity Score (ISS) of 20.63 and comprised 96% men. Most injury mechanisms were blunt (58%). The rate of neurological injury was 19%. There were no cases of progressive neurological deficit or deformity in either cohort. In the VSB group, using a broad definition of pressure ulcer, incidence was 13 of 60 patients (22%). Using a strict definition, incidence was eight of 60 (13%): five Stage I and three Stage II. In the non-VSB group, incidence of pressure ulcers was three of 30 (10%), using either definition, all Stage II. Difference in incidence between the groups was not statistically significant. Intubated patients had a significantly higher incidence of pressure ulcers.
  
  
  CONCLUSIONS
  Both the VSB and historic means (non-VSB) of spinal immobilization appear to be safe and produce only transient morbidity despite an average of 9 to 10 hours of transport. Intubated status was identified as the most important risk factor for the development of a pressure ulcer.
authors.affiliation: Orthopaedic Surgery Service, Department of Surgery, Madigan Army Medical Center, Bldg 9040A Fitzsimmons Dr, Tacoma, WA 98431, USA. Electronic address: james.mok@amedd.army.mil.
authors.forename: James M
authors.initials: JM
authors.lastname: Mok
authors.forename: Keith L
authors.initials: KL
authors.lastname: Jackson
authors.forename: Raymond
authors.initials: R
authors.lastname: Fang
authors.forename: Brett A
authors.initials: BA
authors.lastname: Freedman
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007103:Immobilization / Q000295:instrumentation*; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D003668:Pressure Ulcer / Q000517:prevention & control*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014618:Vacuum
keywords: Combat; Military medicine; Spinal cord injury; Spinal immobilization; Transport